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Country Report Out

Country Report Out. UGANDA. October 23, 2009. Team. Emily Nyanzi , MoH , and Chair person Patrick Luwaga , Private Health Insurance Frederick Makaire, CBHI coordinator Christopher Peter Werikhe , NOTU Chris Atim , Mentor Elodie Montetagaud , Facilitator. Background.

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Country Report Out

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  1. Country Report Out UGANDA October 23, 2009

  2. Team Emily Nyanzi, MoH, and Chair person Patrick Luwaga, PrivateHealthInsurance Frederick Makaire, CBHI coordinator Christopher Peter Werikhe, NOTU Chris Atim, Mentor Elodie Montetagaud, Facilitator

  3. Background • Total Population: 31 Million • 87% of the population live in rural areas • Population Growth rate: 3.2% • Out of Pocket: 38 % of total healthexpenditure • MaternalMortality Rate: 506 / 100 000 • Infant Mortality: 56 / 1000 • Governmentexpenditure on health as % of total governmentexpenditure: 10% • Donorspending on health as % of total healthexpenditure: 28.5%

  4. Current Health Insurance Health Financing There are 3 main schemes in Uganda: • Free HealthCare Policy for All • CommunityBasedHealthFinancing • PrivateSector

  5. Free HealthCare Policy for All • Started in 2002 • Administered by MoHusing budget allocation (no separate budget for policy) • 100% of the population in principle (31 Million) • Uganda National Minimum Health Care Package (UNMHCP) wascostedwith HSSP II • Comprehensivehealth care package but not feasiblewith the lowlevel of funding, (coverseverythingexceptreferralsabroad)

  6. CommunityBasedHealthFinancing(PNFP) Background • Started in 1996 • 33 Schemesexisttoday • 120 000 beneficiaries over 9 districts out of 80 districts Administrative and Managment Structure • Eachschemeisautonomouswithitsownmanagment structure • Community leaders in charge of day to dayscheme management • At national level, the Uganda CommunityBasedHealthFinancing Association (UCBHFA) coordinates all CBI Schemes in the country

  7. CommunityBasedHealthFinancing(PNFP) • Benefit package: OPD, IPD • Exclusions: referrals, chronicdiseases, self inflicted injuries, eye care Challenges: • Scale up in the Free Health Care Policy Environment • Inadequate Local Management Capacity • Low Contributive Capacities

  8. PrivateSector Background • Started in 1994 • 5 HMOs (AAR, IAA, KADIC HealthFoundation and IHN, Case Medicare) • PrivateInsurances (Microcare, Jubilee, NIC, AIG) • Benefit Package: OPD, Referrals, Lab Tests, Imaging, Air/Road Ambulance, In Patient, International Emergency and Hospitalizationoutside Uganda • 250 000 people covered, 0.8 % of total population, mainlyemployees (80%) premium fromemployers and employees Challenges • Benefit Package not affordable for most people • Existing Free Health Care Policy not conducive for PrivateInsurance

  9. Opportunities to expand / improve health insurance Shortcomings of the Free Health Care for All Policy Insufficency of : • funding, • HR, • Drugs, • equipment

  10. Opportunities to expand / improve health insurance • Good existing structure of the health system • Good distribution of service providers (withPPPs in health) • Experience of existingcommunity and privatesector • The international renewedinterest on social health protection

  11. Potential challenges or obstacles • Politicalwill to adress the challenges created by the Free Health Care Policy • Historical background of state provided free social services • Sustainability of donorinterest and support

  12. Actions and next steps that we can take • Sharing with National HealthInsuranceTask Force experiences and lessonslearned • Strengthen and scale up the CommunitybasedHealthInsurance and PrivateSchemesas first steps to NHIS • Continue building consensus amongstakeholders • Mobilizepartners to support sustainablehealthfinancingpolicy

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